Independent Pharmacy

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Dispensing Physician

Coming soon!

Distributor / Wholesaler / Repacker

Coming soon!


Disclaimer

The federal Controlled Substances Act (“CSA”) requires pharmaceutical wholesalers to maintain effective processes to guard against the diversion of controlled substances. The pharmaceutical distribution industry has the responsibility to monitor the distribution of controlled substances to detect orders that are suspicious and might be indicative of diversion. This Questionnaire will assist Top Rx to better understand our customer’s business and their anticipated need for controlled substances to meet legitimate medical needs. This Customer Questionnaire is an important part of our process of evaluating both new and existing accounts. Failure to complete the questionnaire in a timely manner may result in the denial of the request for a new account or suspension of the distribution of controlled substances to an existing account.